What does an A1C level of 7.8 indicate. How does this impact your diabetes risk. What steps can you take to lower your A1C. How do medications play a role in managing high A1C levels.

Decoding A1C: What a 7.8% Level Signifies

An A1C level of 7.8% is a crucial indicator of blood sugar control over the past 2-3 months. This percentage represents the amount of hemoglobin in your blood that has become glycated, or bonded with glucose. At 7.8%, it means that 7.8% of your hemoglobin is saturated with sugar, which is considered high and falls within the diabetes range.

To put this in perspective:

• Normal A1C: Below 5.7%
• Prediabetes: 5.7% to 6.4%
• Diabetes: 6.5% or higher

With an A1C of 7.8%, you’re at an increased risk for developing serious complications associated with diabetes, including cardiovascular disease, nerve damage, kidney problems, and vision loss. It’s essential to work with your healthcare provider to develop a plan to lower your A1C to a healthier range.

Recognizing Symptoms Associated with High A1C Levels

While an A1C of 7.8% may not always present noticeable symptoms, it’s important to be aware of potential signs that could indicate elevated blood sugar levels. These symptoms can include:

• Frequent urination
• Increased thirst and hunger
• Unintentional weight loss
• Fatigue
• Blurred vision

Are these symptoms always present with high A1C levels? Not necessarily. Some individuals may experience no symptoms at all, which is why regular A1C testing is crucial for monitoring your blood sugar control over time.

Factors Contributing to Elevated A1C Levels

Understanding the factors that can lead to high A1C levels is crucial for managing your health effectively. Several elements can contribute to an A1C of 7.8% or higher:

1. Diet: High consumption of refined carbohydrates and added sugars, coupled with low fiber intake
2. Weight: Being overweight or obese
3. Lifestyle: Sedentary habits and lack of regular physical activity
4. Age: A1C tends to increase gradually as you get older
5. Race: Certain ethnic groups have a higher risk of prediabetes and diabetes
6. Stress: Chronic stress can impact blood sugar levels
7. Medications: Some drugs, such as glucocorticoids, can affect A1C levels
8. Family history: Genetic predisposition to prediabetes or diabetes
9. Pregnancy: Gestational diabetes can cause temporary elevations in A1C
10. Chronic diseases: Ongoing inflammation or other health conditions can impact blood sugar control

Can factors unrelated to blood sugar affect A1C results? Yes, certain conditions can lead to falsely high or low A1C readings. These include severe anemia, liver disease, kidney failure, and certain blood disorders. It’s important to discuss any underlying health conditions with your healthcare provider to ensure accurate A1C interpretation.

Strategies to Lower Your A1C Level

If you’ve been diagnosed with an A1C of 7.8%, it’s crucial to take steps to lower this level and improve your overall health. Here are effective strategies to help reduce your A1C:

1. Embrace Regular Physical Activity

Aim for 30-60 minutes of moderate exercise at least 5 days a week. This can include activities such as brisk walking, cycling, swimming, or any form of movement you enjoy. Regular physical activity helps your body use insulin more effectively, lowering blood sugar levels.

2. Optimize Your Diet

Make thoughtful changes to your eating habits:

• Fill half your plate with non-starchy vegetables at each meal
• Include lean proteins and plant-based fats to aid in blood sugar control
• Limit refined carbohydrates and added sugars
• Choose whole grains like quinoa, farro, and steel-cut oats
• Incorporate fiber-rich foods to slow down sugar absorption

3. Maintain a Healthy Weight

If you’re overweight or obese, losing even a small amount of weight can significantly impact your A1C levels. Work with a registered dietitian to develop a sustainable weight loss plan that fits your lifestyle.

4. Manage Stress and Prioritize Sleep

Chronic stress and poor sleep can disrupt hormone balance, affecting blood sugar levels. Incorporate stress-reduction techniques such as meditation, yoga, or deep breathing exercises. Aim for 7-9 hours of quality sleep each night to support overall health and blood sugar regulation.

5. Adhere to Your Treatment Plan

If you’ve been diagnosed with diabetes, follow your healthcare provider’s recommendations closely. This may include taking medications as prescribed, monitoring blood sugar levels regularly, and attending follow-up appointments.

How long does it take to see improvements in A1C levels? While individual results may vary, many people can see significant improvements in their A1C within 3-6 months of implementing lifestyle changes and following their treatment plan consistently.

Medications for Managing High A1C Levels

In some cases, lifestyle changes alone may not be sufficient to bring A1C levels into a healthy range. Your healthcare provider may recommend medications to help manage your blood sugar more effectively. Common diabetes medications include:

• Insulin: Helps cells absorb glucose from the bloodstream
• Metformin: Reduces liver glucose production and improves insulin sensitivity
• Sulfonylureas: Stimulate insulin production in the pancreas
• DPP-4 inhibitors: Help the body continue to produce insulin
• GLP-1 receptor agonists: Slow digestion and reduce appetite
• SGLT2 inhibitors: Increase glucose excretion through urine

Is medication always necessary for managing high A1C levels? Not always. The need for medication depends on various factors, including the severity of your blood sugar elevation, your overall health, and how well you respond to lifestyle changes. Your healthcare provider will work with you to determine the most appropriate treatment approach.

Monitoring and Long-term Management of A1C Levels

Regular monitoring of your A1C is crucial for effective diabetes management. Here are some key points to consider:

• Frequency of testing: Typically every 3-6 months, or as recommended by your healthcare provider
• Target A1C: For most adults with diabetes, the goal is below 7%, but individual targets may vary
• Continuous glucose monitoring: Some individuals may benefit from using CGM devices for real-time blood sugar tracking
• Regular check-ups: Schedule routine visits with your healthcare team to assess your progress and adjust your treatment plan as needed

How often should you check your blood sugar at home? This depends on your individual situation and treatment plan. Some people may need to check several times a day, while others may check less frequently. Your healthcare provider will give you specific recommendations based on your needs.

Potential Complications of Persistently High A1C Levels

Maintaining an A1C level of 7.8% or higher over time can lead to various health complications. Understanding these risks can motivate you to take action and improve your blood sugar control:

Cardiovascular Disease

High blood sugar levels can damage blood vessels and increase the risk of heart disease and stroke. People with diabetes are two to four times more likely to die from heart disease than those without diabetes.

Neuropathy

Elevated blood sugar can cause nerve damage, leading to numbness, tingling, or pain, particularly in the extremities. This can increase the risk of injuries and infections, especially in the feet.

Nephropathy

Diabetes is a leading cause of kidney disease. High blood sugar levels can damage the kidneys’ filtering system, potentially leading to kidney failure over time.

Retinopathy

Persistently high blood sugar can damage the blood vessels in the retina, potentially leading to vision problems or blindness.

Increased Infection Risk

Elevated blood sugar can weaken the immune system, making it harder for your body to fight off infections.

Can these complications be reversed once they develop? While some damage may be irreversible, many complications can be slowed or stopped by achieving and maintaining good blood sugar control. Early detection and treatment are key to preventing or minimizing long-term health issues.

Lifestyle Modifications for Sustainable A1C Management

Achieving and maintaining a healthy A1C level requires a comprehensive approach that goes beyond just medication. Here are some lifestyle modifications that can have a significant impact on your long-term blood sugar control:

1. Meal Planning and Portion Control

Develop a meal plan that balances carbohydrates, proteins, and healthy fats. Use tools like the plate method or carbohydrate counting to help manage portion sizes and maintain steady blood sugar levels throughout the day.

2. Regular Exercise Routine

Incorporate both aerobic exercises and strength training into your weekly routine. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, along with resistance exercises at least twice a week.

3. Stress Management Techniques

Practice stress-reduction techniques such as mindfulness meditation, progressive muscle relaxation, or deep breathing exercises. Consider joining a support group or working with a mental health professional to develop coping strategies for managing diabetes-related stress.

4. Adequate Sleep Hygiene

Establish a consistent sleep schedule and create a relaxing bedtime routine. Aim for 7-9 hours of quality sleep each night to support hormone balance and blood sugar regulation.

5. Regular Health Check-ups

Schedule and attend regular appointments with your healthcare team, including your primary care physician, endocrinologist, ophthalmologist, and podiatrist. These check-ups can help detect and address any potential complications early.

6. Continuous Education

Stay informed about diabetes management by attending educational workshops, reading reputable sources, and discussing new developments with your healthcare provider. Knowledge empowers you to make informed decisions about your health.

How can you stay motivated to maintain these lifestyle changes? Set realistic, achievable goals and celebrate small victories along the way. Consider working with a health coach or joining a diabetes support group to stay accountable and motivated in your journey towards better health.

By implementing these strategies and working closely with your healthcare team, you can effectively manage your A1C levels and reduce your risk of diabetes-related complications. Remember, small, consistent changes can lead to significant improvements in your overall health and well-being.

HbA1c: 7.8

Elle Penner, MPH, RD

5 mins

What does an A1c level of 7.8 mean? Are there any symptoms associated with this A1c level?

An A1c level of 7.8 percent is considered high and means that 7.8% of the hemoglobin in your blood is saturated with sugar. A1c levels of 6.5 or greater are considered diabetes. 

If your A1c is high, a combination of diet and lifestyle changes and medication can help you lower your levels. The lower your A1c, the lower your risk for developing some of the more serious complications of diabetes including cardiovascular disease, nerve and kidney damage, and vision loss.

An A1c of 7.8 may or may not have noticeable symptoms. Some of the symptoms of diabetes include frequent urination, increased thirst and hunger, unintentional weight loss, fatigue, and/or blurred vision.

Factors that could contribute to an A1c level of 7.8: 

 A variety of factors can lead to high A1c levels. Some of these include:  

• Diets that are low in fiber and high in refined carbohydrates and added sugar

• Being overweight or obese

• A sedentary lifestyle

• Age (A1c tends to increase gradually as you get older)

• Race (people of Black, Hispanic/Latino, American Indian, Asian American, or Pacific Islander descent are at greater risk for prediabetes/ diabetes. )

• Stress

• Use of certain medications, including glucocorticoids

• Family history of pre-diabetes or diabetes

• Adherence to your prediabetes/ diabetes management plan

• Pregnancy

• Chronic disease/ inflammation 

Some things can also falsely increase or decrease your A1c result. Let your doctor know if any of these apply to you to determine if you need additional testing:

• Severe anemia, liver disease, or kidney failure

• Certain medicines, including opioids and some HIV medications

• Blood loss or blood transfusions

• Early or late pregnancy

• A less common type of hemoglobin found in people of African, Mediterranean, or Southeast Asian descent, as well as people with blood disorders like sickle cell anemia or thalassemia

What to do if your A1c level is 7.8?

If your A1c is high, a combination of diet and lifestyle changes, and medications can help you lower your levels. The goal for most adults with diabetes is an A1c below 7%, but the lower the better.

Making changes to your diet and adopting healthier habits can help lower your levels. Here are some things you can do to lower your A1c:

• Be active every day: Try to get 30-60 minutes of exercise 5 days per week. 

• Fill half of your plate with non-starchy veggies at every meal, and include lean protein and plant-based fat to assist with blood sugar control. 

• Limit refined carbohydrates and added sugar; choose whole-grain carbs like whole wheat bread and pasta, quinoa, farro, and steel-cut oats, instead. 

• Lose weight if you are overweight or obese.

• Manage stress and get adequate sleep to help balance hormone levels that can impact blood sugar.

• Follow your diabetes treatment plan if you have been diagnosed with diabetes.

Medications used to improve A1c results

Medications, along with healthy diet and lifestyle changes, can help to lower elevated A1c levels into a safer range. Your doctor and/or dietitian will work with you to determine which ones are right for you, if necessary. Some common diabetes medications include: 

• Insulin: Typically given by injection or through a pump to increase glucose (sugar) uptake by cells and thus decrease blood sugar

• Sulfonylureas: Increase insulin production by stimulating insulin-producing beta cells in the pancreas

• Alpha-glucosidase inhibitors: Help your body break down starches and sugars found in food, lowering your blood sugar levels. 

• Biguanides: Reduce the amount of sugar your liver produces, as well as how much sugar your intestines absorb and makes your body more sensitive to insulin. The most common biguanide is metformin. 

• Dopamine agonist: These medications work by affecting the way the brain processes dopamine, an important neurotransmitter (chemical messenger). By increasing the activity of dopamine receptors, dopamine agonists increase insulin sensitivity, allowing cells to use blood glucose more effectively and lower blood sugar.

• DPP-4 inhibitors: Help the body continue to make insulin, which lowers blood sugar

• GLP-1 receptor agonists: Increase growth of insulin-producing beta-cells in the pancreas, slow stomach emptying, and decrease appetite and how much glucagon (which raises blood sugar) your body uses

• Meglitinides: Similar to sulfonylureas (but by a different mechanism) meglitinides stimulate the pancreas to release insulin in response to a meal. This increase in insulin production helps lower blood sugar.

• SGLT 2 inhibitors: Prevent the kidneys from holding on to glucose and increasing its excretion in urine

• Thiazolidinediones: Decrease glucose in your liver and also help your fat cells better utilize insulin

What Is a Dangerous Level of A1c?

A glycated hemoglobin A1c test (HbA1c), or A1c test for short, is a blood test that tells you your average blood glucose levels over the previous 2-3 months.  

This is a standard test that people with diabetes routinely get to assess the overall management of their blood sugar levels and to course-correct treatment plans. 

But what is a dangerous level of A1c? This article will investigate A1c levels that are considered both too low and too high, and what to do about improving yours if it is at a dangerous level. 

Table of Contents

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What is an A1c? 

An A1c is a blood test that is typically taken in a laboratory and measures the hemoglobin in your blood. 

Hemoglobin is a protein found in your red blood cells and gives blood its red color. It carries oxygen throughout your body and is crucial for good health. 

This test measures the average amount of blood glucose attached to the hemoglobin in your red blood cells over the past few months. Red blood cells regenerate every 3 months, which is why the test will only show your average blood glucose level for the previous 2-3 months.  

It is usually skewed toward the preceding several weeks before a test. 

What is the importance of an A1c? 
An A1c test helps diagnose diabetes
The A1c is an important tool for diagnosing type 1 and type 2 diabetes, prediabetes, and even sometimes gestational diabetes.
If your results reveal prediabetes, your doctor will probably recommend that you get a repeat A1c test done annually or semi-annually. Additionally, for people 45 and older, the Centers for Disease Control and Prevention (CDC) recommend an A1c test every 3 years. 
If you have prediabetes, you should talk with your doctor about steps you can take to reduce your risk of developing diabetes. 
Your doctor may recommend you get an A1c test if you’re under the age of 45 but have certain risk factors for diabetes, including: 
Being overweight or obese
Having a family history of diabetes
Having hypertension (high blood pressure)
Previously had gestational diabetes 
Are an ethnic minority 
Having heart disease
Live a sedentary lifestyle/physical inactivity 
You should call your doctor right away if you experience the following symptoms, as they are signs of diabetes: 
Extreme thirst
Frequent urination
Unexplained weight loss 
Blurry vision/changes in vision 
Extreme hunger
Fruity-smelling breath 
Lethargy 
Body aches and/or headache 
Your doctor may recommend you get an A1c test or seek emergency medical care, depending on the severity of your symptoms.
You can also test your A1c at home with a test kit you can buy at your local pharmacy or online.
 
An A1c test determines general diabetes control 
For people with existing diabetes, a quarterly A1c test is usually ordered to determine your average blood sugar levels, and general diabetes control, over the previous 3 months. 
A1c tests are great at detecting if your blood sugars are consistently running high or low, and can help you change your diabetes therapies to help prevent complications such as heart disease, retinopathy, neuropathy, kidney disease, and premature death.
However, since an A1c test is merely an average of your previous 3 months’ blood sugar levels, it will average out all of the high blood sugar levels with all of the low blood sugar levels. This can potentially give you a false sense of accomplishment if, in fact, you’re just riding the blood sugar rollercoaster most days! 
If, however, your blood sugar levels are moderately stable, it can give you a great sense of how well you’re managing to keep your blood sugars in range.  
 
What are the different A1c levels? 
The American Diabetes Association uses the following definition to determine if you have diabetes or prediabetes:
Normal, no diabetes: A1c below 5.7%
Prediabetes: A1c between 5.7% and 6.4%
Diabetes: A1c of 6.5% or higher 
Individual A1c goal levels will vary by person. For example, for someone who doesn’t detect their low blood sugars, or for someone with diabetes who lives alone, their doctor may recommend a slightly higher A1c. 
On the other hand, for someone with existing diabetes who is pregnant, an A1c of or below 6% is ideal, as long as they’re not experiencing too many low blood sugars. 
American Diabetes Association  (ADA) advises A1c levels to stay below 7% to help prevent diabetes complications for adults, and below 7.5% for children. 
 
What is a dangerous A1c level? 
There are dangers to having both a too-high and a too-low A1c level. Always work with your doctor to see what A1c level should be your goal, depending on your lifestyle, health goals, and life stage. However, some dangerous ranges would be best to avoid.
An A1c lower than 5% 
While diabetes management is becoming more precise with faster insulins, closed-loop insulin pumps, continuous glucose monitoring (CGM) systems, and better access to diabetes self-management education (DSME), people with diabetes are achieving lower A1cs than ever before. 
This is a great accomplishment if you’re not experiencing too many low blood sugars. 
Remember, an A1c is just an average blood sugar of the previous three months, so if your A1c is lower than 5%, that may be an indicator that you’re having too many lows. 
Even if you’re not experiencing severe low blood sugar that often if you’re older, live alone, have trouble detecting your low blood sugars (have hypo-unawareness), or do not have a continuous glucose monitor (CGM) with low alerts set on, it can be dangerous to have an A1c that low.  
A 5% A1c indicates that your average blood sugar is only 97 mg/dL. 
This means that even a moderate walk or hot shower could send your blood sugar plummeting at any minute, which can be risky. 
Low blood sugars can lead to severe diabetes complications, including diabetic coma and death, so it’s crucial that you prevent severe low blood sugars and have fast-acting glucose or glucagon available in case of an emergency. 
If you live alone, are older, have hypo-unawareness, do not have a CGM, or are simply experiencing too many lows, talk with your doctor about lowering your insulin doses to help prevent dangerous lows and increase your A1c. 
To note: Pregnant people may have an A1c under 5%, and if they’re not experiencing many low blood sugar levels, this may be fine. 
Additionally, at the beginning of a type 1 diabetes diagnosis, many people experience what is known as the “honeymoon phase” where their pancreas is still emitting some insulin, and they may have an extremely low A1c for the first several months to a year after diagnosis.  
This is normal, but if you’re in the honeymoon phase with too many low blood sugars, talk with your doctor. 
 
An A1c higher than 7% 
While the ADA recommends that most adults maintain an A1c of 7% or lower (and children maintain an A1c of 7.5% or lower), this isn’t always possible. 
Competing priorities, money, time, energy, hormones, jobs, school, stress, and everyday life make managing diabetes really hard, and sometimes we struggle with higher-than-ideal blood sugar levels and that is okay! 
An A1c is 7% is an average blood sugar level of 154 mg/dL and an A1c 0f 7.5% is an average blood sugar level of 169 mg/dL, both of which are reasonable numbers (especially if you’re a child who is wont to not always finish meals or an adult who struggles to detect dangerous low blood sugars). 
Most times, especially during busy or stressful times of life, an A1c of between 7-8% is not dangerous and won’t pose any problems for your health.  
 
An A1c higher than 9% 
However, numbers much higher than 9% can start to put you at risk for diabetes complications later on in life. 
According to the American Diabetes Association’s Standards of Medical Care in Diabetes, 2022, an A1c of 9% puts one at a higher risk for blindness, heart attack, nerve damage, and kidney failure. 
An A1c is 9% is equal to an average blood sugar level of 212 mg/dL. 
The higher your A1c, the more dangerous it is and the more likely you are to suffer from diabetes complications. 
The following are A1c levels to average blood sugar levels: 
10 % = 240 mg/dL
11% = 269 mg/dL
12% = 298 mg/dL
13% = 326 mg/dL
14% = 355 mg/dL 
For more detailed information, read How to Translate Your A1c to a Blood Sugar Level.
Prolonged high blood sugars over time can lead to severe diabetes complications, such as retinopathy, neuropathy, heart disease, kidney disease, lower-limb amputations, stroke, and even premature death.  
If you’re struggling to lower your A1c, talk to your doctor about increasing or changing your medication regimen, diet, physical activity level, addressing any mental health issues, or if they suggest other ways to help you better manage your blood sugar levels. 
To note: at diagnosis, especially with type 1 diabetes, a person will typically have an extremely elevated A1c level. 
This does not automatically mean that you will suffer long-term diabetes complications. Usually, after a few months of insulin therapy and treatment, A1c levels drop extremely quickly and there is no risk of serious future complications. 
 
Ways to make your A1c safer 
There are ways to both increase and decrease your A1c if you’re falling into the danger zone. 
If your A1c is too low 
Work with your doctor to decrease your medications and/or insulin
Decrease the amount of exercise you do, if you’re struggling with lows after physical activity
Increase the amount of protein and fat in your diet to help prevent low blood sugars overnight
If you don’t already have one, use a CGM to catch low blood sugar levels before they become dangerous
Utilize an insulin pump and use temporary basal settings for things like exercise and other physical activity to help prevent low blood sugars 
If your A1c is too high 
Work with your doctor to increase your medications and/or insulin 
Increase the amount of physical activity you do each day
Eat lower carbohydrate meals and eat plenty of whole foods with fiber
If you struggle with counting carbohydrates, start a food journal and work with a registered dietitian (RD) to help you meal plan 
Avoid processed foods and foods and drinks with added sugar 
Check your blood sugar multiple times a day, or utilize a CGM to help catch high blood sugars sooner
Utilize an insulin pump that can use different basal rates throughout the day and night to help prevent prolonged high blood sugars 
Get plenty of sleep (aim for between 7-9 hours per night for better insulin sensitivity) 
Manage stress with yoga, meditation, and breathing to decrease insulin resistance 
 
Summary
While there is a lot of talk about the dangers of a high A1c, there isn’t much talk about the dangers of a low A1c, and there is a lot of confusion as to what is actually dangerous and what to do about it.  
For most people, a good and safe A1c lies anywhere between 5-8%, although this will vary from person to person. 
If you’re pregnant, your A1c should be lower, and if you live alone or struggle with low blood sugars, your doctor may want your A1c on the higher end. 
However, an A1c that is routinely under 5% can pose a danger of too many and too severe low blood sugars, which can cause diabetic coma and death. 
An A1c of 9% or above increases your risk for diabetes complications, including heart disease and heart attack, stroke, retinopathy and blindness, nerve damage and amputation, kidney disease and kidney failure, and ultimately, premature death. 
Work with your doctor to adjust your medications, increase or decrease your physical activity, alter your diet, and better regulate sleep and stress to help you land your goal A1c. 
While there is no “perfect” A1c, no one should have to live with an A1c at a dangerous level that is harmful to one’s health and well-being.   
 Glycosylated hemoglobin – what is it, the norm in women and men
 
 It is very important in the management of patients with diabetes to achieve optimal blood glucose levels. The patient can control the level of glucose in the blood independently (with portable glucometers) or in the laboratory.
 The result of a single determination of glucose in the blood shows the concentration of glucose at the time of taking, therefore, it is not possible to make any assumptions about the state of the patient’s carbohydrate metabolism between measurements. It is possible to assess the patient’s carbohydrate metabolism over a long period of time only by measuring the concentration of glycosylated hemoglobin in the blood, according to the recommendations of the Committee for the Control of Diabetes and its Clinical Complications (DCCT).
 According to DCCT studies, it has been shown that the risk of development and progression of long-term complications of type 1 diabetes is closely related to the degree of effectiveness of glycemic control, expressed in the content of glycated hemoglobin in the blood [10]. Specialists from the UK have shown that a decrease in the patient’s blood glucose, assessed by the concentration of HbA1c, reduces the incidence of microangiopathies in type 2 diabetes mellitus [4].
 Characteristics of indicator 
 Glycosylated hemoglobin (the term “glycated hemoglobin” is also used) is formed as a result of the non-enzymatic addition of glucose to the N-terminal regions of the β-chains of hemoglobin A1  globin and is designated as HbA1c. The concentration of HbA1c is directly proportional to the average concentration of glucose in the blood. In healthy people, the concentration of HbA1c in the blood is from 4.80 to 5.90%, in patients with diabetes its level is 2-3 times higher (depending on the degree of hyperglycemia).
 The resulting HbA1 accumulates inside the erythrocytes and persists throughout the life of the erythrocyte. The half-life of erythrocyte circulation in the bloodstream is 60 days, thus, the HbA1c concentration reflects the patient’s glycemia level 60-90 days before the study [2, 3].
 A huge number of studies using traditional methods for measuring glucose content have confirmed the relationship between HbA1c and the level of glycemia of the patient [12-14]. Results of studies conducted by DCCT in 90s, served as the basis for confirming the hypothesis that the level of HbA1c reflects the level of glucose in the blood and is an effective criterion for monitoring patients with diabetes mellitus.
 Standardization of methods for the study of glycosylated hemoglobin 
 In the early 90s, there was no interlaboratory standardization of methods for measuring glycosylated hemoglobin, which reduced the clinical effectiveness of this test [15-17]. In this regard, the American Association of Clinical Chemistry in 1993 formed a subcommittee on the standardization of methods for measuring glycated hemoglobin. As a result of his work, the National Glycosylated Hemoglobin Standardization Program (NGSP) was developed. Manufacturers of test systems for measuring glycated hemoglobin have been required to undergo rigorous testing to ensure that the results correspond to data obtained by reference DCCT methods. In case of a positive result of the check, the manufacturer is issued a “DCCT certificate of conformity”. The American Diabetes Association recommends that all laboratories use only NGSP-certified tests [7].
 There are currently many methods for studying glycosylated hemoglobin:
 liquid chromatography;
 affinity chromatography;
 electrophoresis;
 column techniques;
 immunological methods.
 When a laboratory chooses an analyzer for glycated hemoglobin testing, preference should be given to analyzers based on the DCCT reference method, which is liquid chromatography. The use of standardized test methods enables the laboratory to obtain results that can be compared with data obtained using reference methods and published by DCCT. Such a comparison maximizes the reliability of the research results.
 It is extremely important that the attending physician use in his work the results of studies obtained only in those laboratories that conduct the study of glycosylated hemoglobin using NGSP certified methods.
 Study of HbA1c concentration in the laboratories of the Citylab Association 
 The concentration of glycosylated hemoglobin (HbA1c) in the laboratories of the Citilab Association is determined by the reference method (DCCT) of high performance liquid chromatography (HPLC), (the method is certified by NGSP), on D 10 analyzers from Bio-Rad, which is the world leader in the manufacture of glycosylated hemoglobin analyzers. This study is 23-10-002 – Glycosylated hemoglobin.
 Mean blood glucose assessment 
 The DCCT study group demonstrated the clinical relevance of HbA1c as an estimate of mean blood glucose concentration (over 60-90 days). In these studies, patients had their daily glucose profile recorded every 3 months (seven measurements daily). The resulting profile was compared with the level of HbA1c. Over 36,000 studies have been conducted over 9 years. Empirically, a linear relationship between the average glucose content and the HbA1c level was obtained:
 Average glucose concentration (mg / 100 ml) = 30. 9 x (HbA1c) -60.6, where:
 HbA1c is the concentration of glycosylated hemoglobin.
 Simply put, a 1% change in HbA1c corresponds to a 30 mg/100 ml (1.7 mmol/L) change in mean glucose.
 Note: This relationship was obtained in the study of glucose concentration in capillary blood. The concentration of glucose in the blood serum is approximately 15% higher.
 The diagram (Fig. 1) [11] can be used to interpret the results of HbA1c studies.
 Rice. 1. Diagram of the control of carbohydrate metabolism in patients with diabetes mellitus
 Note: The concentration of glucose is indicated in mmol / l, in brackets in mg / 100 ml, 1 – High risk of developing long-term complications such as retinopathy, nephropathy and neuropathy. 2 – Increased risk of hypoglycemic reactions in patients with type 1 or type 2 diabetes when taking insulin or oral hypoglycemic drugs.
 To convert glucose concentration in mg/100 ml to SI units (mmol/l), the following formula is used:
 Glucose (mg/100 ml) x 0. 0555 = Glucose (mmol/l)
 Recommended testing frequency 
 The American Diabetes Association recommends that for patients whose therapy has been successful (stable carbohydrate metabolism), an HbA1c test should be performed at least 2 times a year, while in case of a change in diet or treatment, the frequency of testing should be increased to 4 times a year [7]. In the Russian Federation, according to the Targeted Federal Program “Diabetes Mellitus”, HbA1c testing should be carried out 4 times a year for any type of diabetes [1].
 According to the American Diabetes Association, women with diabetes in the pre-pregnancy period need a special monitoring regimen. It is recommended to reduce the level of HbA1c in order to create optimal conditions in the body of the future mother for conception and fetal development. At the beginning, HbA1c should be tested monthly. When carbohydrate metabolism is stabilized with appropriate therapy, HbA1c testing should be performed at intervals of 6-8 weeks prior to conception [5, 6].
 Modern studies have shown that many patients do not comply with the recommended interval between studies [8], however, experts have come to a common opinion that regular studies of HbA1c levels significantly reduce the risk of complications in patients with diabetes mellitus.
 Interpretation of test results 
 The goal of hypoglycemic therapy in diabetes mellitus is to normalize blood glucose levels. DCCT studies have shown that intensive treatment prevents the patient from developing long-term complications such as retinopathy, nephropathy and neuropathy, or significantly delays their clinical manifestation. If patients strictly adhere to a regimen aimed at normalizing carbohydrate metabolism, the incidence of retinopathy decreases by 75%, nephropathy – by 35-36%, and the risk of polyneuropathy decreases by 60% [10].
 Below are the therapeutic goals in the treatment of diabetes mellitus according to the Target Federal Program “Diabetes Mellitus”.
 Table 1.
 Therapeutic goals in the treatment of type 1 diabetes mellitus [1, 18]
 Name of the study
 Reference values
 Adequate level
 Inadequate
 level
 Self-monitoring of blood glucose, mmol/l (mg%)
 on an empty stomach
 4.0 – 5.0 (70 – 90)
 5.1 – 6.5 (91 – 117)
 >6.5 (>117)
 2 hours after eating
 4.0 – 7.5 (70 – 135)
 7.6 – 9.0 (136 – 162)
 >9.0 (>162)
 before bedtime
 4. 0 – 5.0 (70 – 90)
 6.0 – 7.5 (110 – 135)
 >7.5 (>135)
 HbA1c
 <6
 6.1 – 7.5
 > 7.5
 Table 2.
 Therapeutic goals in the treatment of type 2 diabetes mellitus [1, 19]
 Name of the study
 low risk
 angiopathy
 Risk
 macroangiopathies
 Risk
 microangiopathy
 Self-monitoring of blood glucose, mmol/l (mg%)
 on an empty stomach
 <5. 5 (<100)
 >5.5 (>100)
 >6.0 (>110)
 2 hours after eating
 <7.5 (<135)
 >7.5 (>135)
 >9.0 (>160)
 HbA1c
 <6.5
 >6.5
 >7.5
 Note: In parentheses are glucose values ​​in mg/100 ml.
 The Federal Target Program “Diabetes Mellitus” [1] adopted the values ​​recommended by the European Committee for Diabetes Recommendations [18, 19].
 When evaluating the results of treatment in patients with concomitant diseases, young people, the elderly, pregnant women and patients with an unusual pattern of diabetes mellitus, other criteria for stabilizing carbohydrate metabolism should be used.
 With an inadequate level of carbohydrate metabolism in a patient, additional measures are necessary, which depend on the clinical picture of the patient’s disease, such measures may include:
 enhanced patient education on self-monitoring of glucose levels;
 organization of patient support groups;
 regular examination by an endocrinologist;
 changes in drug therapy;
 more frequent testing of glucose and HbA1c.
 Conclusions 
 The HbA1c study allows to assess the level of glycemia in a patient with diabetes mellitus for 60-90 days prior to the study.
 This study provides an opportunity to monitor the course of the disease and control the adequacy of the treatment.
 An HbA1c test should be performed to assess the risk of complications in a diabetic patient.
 References 
 Dedov I.I., Shestakova M.V., Maksimova M.A. Federal target program “Diabetes mellitus”. // Moscow, 2002, 84 p.
 Peters – Harmel E., Mathur R. Diabetes mellitus. Diagnosis and treatment. // Practice, 2008.
 Popova Yu.S. Diabetes. // Krylov, 2008.
 AD. Implications of the United Kingdom Prospective Diabetes Study (Position Statement). // Diabetes Care 1999, (SI), 27-31.
 AD. Standards of Medical Care for Patients With Diabetes Mellitus (Position Statement). // Diabetes Care 1999, (SI), 32-41.
 AD. Preconception Care of Women With Diabetes (Position Statement). // Diabetes Care 1999, (SI), 62-63.
 AD. Tests of Glycemia in Diabetes (Position Statement). // Diabetes Care 1999, (SI), 77-79.
 Auxter S. Another Study Shows Laboratory Tests are Underutilized. // Clin Lab News 1998, 24(9): 24-5.
 Bodor G., Little R., Garrett N. et al. Standardization of Glycohemoglobin Determinations in the Clinical Laboratory: Three Years Experience. // Clin Chem 1992; 38:2414-18.
 DCCT Research Group. The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long – Term Complications in Insulin – Dependent Diabetes Mellitus. // Engl J Med 1993; 329:977-86.
 Goldstein D.E., Little R.R. Bringing Order to Chaos: Standardizing the Hemoglobin A1c Assay. // Contemp Int Med 1997; 9(5): 27-32/
 Gonen B.A., Rubinstein A.H., Rochman H. et al. Hemoglobin A1: An Indicator of the Metabolic Control of Diabetic Patients. // The Lancet 1977, Oct 8; 2(804): 734-7.
 Koenig R.J., Peterson C.M., Kilo C. et al. Hemoglobin A1c as an Indicator of the Degree of Glucose Intolerance in Diabetes. // Diabetes 1976, 25(3): 230-2.
 Koenig R.J., Peterson C.M., Jones R.L. et al. Correlation of Glucose Regulation and Hemoglobin A1c in Diabetes Mellitus. // Engl J Med 1976, 295(8): 417-20.
 Little R.R., England J.D., Wiedmeyer H.M. et al. Interlaboratory Standardization of Glycated Hemoglobin Determinations. // Clin Chem 1986; 32:358-60.
 Little R.R., England J.D., Wiedmeyer H.M. et al. Interlaboratory Comparison of Glycated Hemoglobin Results: College of American Pathologists (CAP) Survey Data. // Clin Chem 1991; 37:1725-29.
 Little R.R., England J.D., Wiedmeyer H.M. et al. Interlaboratory Standardization of Measurements of Glycohemoglobin. // Clin Chem 1992; 38:2472-78.
 European Diabetes Policy Group. Guidelines for a desktop guide to Type 1 (insulindependent) Diabetes Mellitus. – International Diabetes Federation European Region. – 1998.
 European Diabetes Policy Group. Guidelines for a desktop guide to Type 2 Diabetes Mellitus. – International Diabetes Federation European Region. – 1998 – 1999.
 What is glycated hemoglobin, what does it mean in a blood test and what is its norm 
 Many people do not know why they donate glycated hemoglobin. In fact, this is an important indicator with which you can track the development of diabetes. According to this coefficient, it is easy to detect the disease at the earliest stages, and begin treatment.
 What does glycated hemoglobin mean? 
 Often, even people with diabetes do not know what glycated hemoglobin is. Everything is very simple. When a person consumes carbohydrates, sugars enter the bloodstream. They pass through the erythrocyte membrane. Their amino acids react with sugars to form glycated hemoglobin. The compound is very stable, its concentration persists for 120 days, after which the red blood cells are destroyed.
 All people have glycated hemoglobin. The difference between healthy and diabetic people is only in its concentration. This indicator displays how correctly carbohydrate metabolism processes are going on in the body. If there are failures and the sugar level is elevated, then the indicator will be more than normal.
 These figures can be used to detect latent diabetes, because the parameter displays the sugar level not at a specific moment when it is easy to lower it, but for 3 months. It is important during treatment, to monitor the patient’s condition.
 Therefore, what is glycated hemoglobin in a blood test, every person should know, especially those who are already at risk or have diabetes.
 How to donate blood for glycated hemoglobin? 
 The glycated hemoglobin test does not require any specific preparation. It is taken in the morning, blood is taken from a vein. Thyroid disease, systematic intake of vitamins, anemia can affect the results.
 Eaten food does not distort the result, just like alcohol, stress the day before, SARS and influenza.
 What is the norm of glycated hemoglobin? 
 In order not to worsen your condition, you need to know not only what glycated hemoglobin in the blood means, but also to know your norm.
  The indicator depends on age: 
 For adolescents and people under 30 years old, an indicator that does not exceed 6. 5% is considered the norm.
 In middle age (from 30 to 50 years old), the parameter should not exceed 7%.
 For elderly people who are over 60 years old, an increase of up to 7.5% is acceptable, but no more.
 In a healthy child, the indicator is the same as in adults. Its normal range is from 4.5 to 6%. If deviations from these norms are found, it is necessary to undergo an additional examination to determine why the blood sugar level is elevated. Usually, with indicators of 6.1-6.4% (doctors call this condition prediabetes), health control needs to be strengthened.
 If there is no suspicion of diabetes, then it is enough to undergo such a test once every 2-3 years. If the indicator is fixed at an elevated level, this means that the test must be carried out every year. Depending on the progression of the disease, a doctor may recommend that a patient with diabetes be tested every 3 or 6 months.
 What is the norm for diabetics? 
 For physicians, the glycated hemoglobin value can tell a lot. Determination of its level provides more thorough control of sugar and correction of the diet, treatment regimen, dosage of drugs. For those diagnosed with diabetes, levels of less than 8% are normal. A parameter that is higher than this value indicates the possibility of serious complications. But you can’t lower it too sharply, it will only get worse, because. the body is already accustomed to a high concentration of glucose.
 At a young age, you should strive to keep it within 6.5-7%, on average from 7 to 7.5%, after 50 make sure that the figure is not higher than 7.5-8%.
 How to reduce the level of glycated hemoglobin? 
 It should be remembered that glycated hemoglobin determines to bring these numbers back to normal. It shows the average glucose level over 3 months, not at a specific point in time. Therefore, this indicator at home can be reduced only by reducing excess weight and improving metabolism.
  And for this you need: